Potassium is the most abundant electrolyte found in the body. Electrolytes are electrically charged ions that the body needs to function properly. Potassium in present in all cells in the body. The 2004 guidelines of the Institute of Medicine specify a recommended daily allowance (RDA) of 4.7 grams of potassium for adults. Fruits and vegetables are dietary sources of potassium. Salt substitutes also contain high levels of potassium.

Hypokalemia (low levels of potassium in the blood serum) may cause muscle cramps and pain, weakness, and cardiovascular abnormalities. Hypokalemia may be caused by decreased potassium intake, vomiting, burns, dialysis, sweating, various medications orsupplements, and low levels of magnesium. Potassium supplementation is approved by the U.S. Food and Drug Administration (FDA) for the treatment of hypokalemia.

Hyperkalemia (too much potassium in the blood serum) may cause potentially severe problems to the brain and the neural and cardiovascular systems. Hyperkalemia may be caused by increased potassium intake, decreased potassium excretion, or redistribution of potassium caused by medications or supplements.

There is evidence from human studies that potassium is an effective treatment for hypertension (high blood pressure). There is limited or conflicting evidence for the use of potassium in cardiovascular disease or osteoporosis prevention, heart protection during surgery, or the treatment of alcohol withdrawal, critical illness, dehydration in elderly patients, dentin (teeth) hypersensitivity, diarrhea, edema (swelling), kidney stones, kwashiorkor (malnutrition), myocardial infarction (heart attack), pre-eclampsia (hypertension and other problems during pregnancy), thallium poisoning, rheumatoid arthritis, and stroke. Large-scale, high-quality human trials are needed in these areas.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Potassium deficiency, or hypokalemia, may occur for various reasons, including decreased potassium intake, increased potassium excretion caused by certain drugs, loss of potassium due to vomiting, or decreased potassium absorption. Potassium is approved by the U.S. Food and Drug Administration (FDA) for the treatment of hypokalemia.

A

Information from laboratory experiments and studies performed in humans indicate that increased dietary potassium may decrease diastolic and systolic blood pressure. However, there is some conflicting evidence from other studies. Further research is warranted.

B

The use of potassium supplementation in alcohol withdrawal to maintain electrolyte levels has been assessed with mixed results. Further trials are warranted.

C

It has been reported that the favorable impact of diets rich in fruit and vegetables on heart health may be due to the potassium supplied by these foods. Studies performed in humans have found that a high dietary potassium intake may cause a decrease in the risk of coronary heart disease and cardiovascular disease. Further research is warranted.

C

Hyperglycemia (increased blood glucose) is a common problem in patients with critical illnesses who are in hospital wards and intensive care units. Hyperglycemia has been reported to increase the risk of mortality and morbidity in hospitals. Tight control of glycemia may improve patient outcomes. The use of glucose, insulin, and potassium (GIK) has been proposed to have several beneficial effects. In studies performed in humans, the results are mixed. Further research is needed.

C

Dehydration in the elderly is a common and serious condition, due to various factors. Limited evidence in humans suggests that potassium chloride may be used in hypodermoclysis (subcutaneous infusion) to treat dehydration. Further research is warranted.

C

Dentin is the layer of tooth between the enamel and the pulp layers. Multiple forms of potassium salts have been studied for their affects on dentin to decrease sensitivity. In humans, potassium-containing therapies have shown mixed results. Further studies are warranted.

C

Many electrolytes are decreased in patients with diarrhea, including potassium. It is common clinical practice to treat diarrhea with oral rehydration solutions that contain potassium and other electrolytes. Rehydration with such solutions has been reported to decrease death in children due to diarrhea.

C

Potassium has been supplemented, in addition to diuretics, in the treatment of edema (swelling) of cardiac origin, with beneficial effects. Further studies are warranted.

C

Cardiac surgery is associated with several risks, including atrial fibrillation. Glucose-insulin-potassium (GIK) therapy may help to decrease the risk of morbidity and mortality associated with atrial fibrillation. In patients undergoing cardiac surgery, GIK has been used with mixed results. Further research is warranted.

C

Hypercalciuria, or high levels of calcium in the urine, may lead to kidney stones. Potassium citrate has an inhibitory activity on calcium oxalate crystallization, aggregation, and agglomeration and has shown benefit in patients at risk of kidney stones. There is evidence that potassium-magnesium citrate is effective at decreasing the recurrence of calcium stones in patients without symptoms. Thiazides and neutral potassium phosphate decreased urinary calcium levels in symptomatic patients. Although the results in this area are promising, further research is needed.

C

Kwashiorkor is a form of malnutrition that occurs when there is not enough protein in the diet. Potassium depletion is common and contributes to the high mortality rate associated with kwashiorkor. In children, high potassium supplementation was a beneficial kwashiorkor treatment. Further research is needed.

C

The use of glucose-insulin-potassium (GIK) for myocardial infarction (heart attack) has been in practice for over 40 years. In human studies, GIK administration resulted in reduced mortality from myocardial infarction, although further research is needed in this area.

C

In healthy children, a high dietary potassium intake correlated with high bone density. Low dietary potassium intakes are associated with low bone mineral density in premenopausal women and risk of bone loss in postmenopausal women. In women, increasing dietary potassium intake may contribute to a decreased risk of osteoporosis. Further research is needed in this area.

C

Thallium poisoning occurs in cases of suicide, murder attempt, or accident. Thallium is considered one of the most toxic heavy metals. It enters the potassium distribution pathways and alters a number of potassium-dependent processes. Potassium treatment increases the clearance of thallium by the kidneys but should be used cautiously, due to the risk of neurologic and cardiovascular toxicities.

C

A case control study found that diets high in fiber and potassium are associated with a reduced risk of hypertension, indicating that maternal intake of foods rich in potassium and other nutrients may reduce the risk of pre-eclampsia. Further studies are warranted.

Low potassium intake and low serum potassium are associated with increased stroke mortality. High potassium intake was associated with a decrease in stroke incidence in adults. Further research is required to determine if potassium supplementation would prevent stroke.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

The 2004 guidelines of the Institute of Medicine specify an recommended daily allowance (RDA) of 4.7 grams of potassium for adults. Initial dosages may be adjusted to specific patient needs based on steady-state serum potassium concentrations.

Oral potassium chloride should be taken with food and/or a full glass of water to prevent gastrointestinal irritation. Dissolvable potassium chloride tablets, powder, or concentrated solutions may be mixed with 3-8 ounces of water.

For hypertension, 17-200 millimoles of potassium supplements (potassium chloride, potassium citrate, potassium bicarbonate, etc.) or dietary potassium daily has been used for five days to 28 weeks.

For treatment of hypokalemia, 40-100 milliequivalents have been taken by mouth once daily, using formulations that include normal-release tablets or capsules, extended-release tablets or capsules, dissolvable tablets, oral solution, or powder for dissolution mixed with an appropriate volume of water or juice. 40-100 milliequivalents of potassium chloride for injection diluted in an appropriate amount and type of solution have been infused in the vein once at a rate not exceeding 10-40 milliequivalents per hour.

For prevention of hypokalemia, 10-20 milliequivalents have been taken by mouth once daily in equally divided doses, using formulations that include normal-release tablets or capsules, extended-release tablets or capsules, dissolvable tablets, oral solution, or powder for dissolution mixed with an appropriate volume of water or juice. 10-40 milliequivalents of potassium chloride for injection diluted in an appropriate amount and type of solution have been infused in the vein once at a rate not exceeding 40 milliequivalents per hour.

For rheumatoid arthritis, 6,000 milligrams of potassium chloride dissolved in grape juice and taken by mouth for 28 consecutive days with normal medications has been used.

For dentin hypersensitivity, toothpastes, solutions, gels, and mouth rinses that have been used have included 1-15% KNO3 and/or 30% potassium oxalate solution.

For infusions, the maximum recommended concentration is 60 milliequivalents of potassium per liter of intravenous (infused in the vein) fluid. Potassium chloride solutions should be infused slowly (up to 20 milliequivalents per hour) to avoid venous irritation and pain. Monitoring the serum potassium concentration is recommended.

For dehydration, 34 millimoles per liter of potassium chloride, at an infusion rate of 250-333 milliliters per hour, has been used.

Children (under 18 years old)

Potassium chloride by mouth should be taken with food and/or a full glass of water to prevent gastrointestinal irritation. Dissolvable potassium chloride tablets, powder, or concentrated solutions may be mixed with 3-8 ounces of water.

For treatment of hypokalemia, 2-5 milliequivalents taken by mouth in equally divided doses, using age-appropriate oral dosage formulations, have been used. 0.5-1 milliequivalents per kilogram per dose (with a maximum dose of 30 milliequivalents) of potassium chloride for injection diluted in an appropriate amount and type of solution to has been infused in the vein once at a rate not exceeding 0.3-0.5 milliequivalents per kilogram per hour. Monitoring the serum potassium concentration is recommended.

For prevention of hypokalemia, 1-2 milliequivalents have been taken by mouth in equally divided doses, using age-appropriate oral dosage formulations.

For kwashiorkor, 4.7-7.7 millimoles of potassium per kilogram of body weight has been taken by mouth.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid potassium products in patients with known allergy or hypersensitivity to ingredients in potassium-containing products.

Side Effects and Warnings

Side effects of potassium supplementation may include high blood levels of potassium, increased blood pressure, stinging or irritation from application, and gastrointestinal side effects (pain, burping, nausea, vomiting, diarrhea, stool color change, and gas). High levels of potassium in the serum, or hyperkalemia (serum potassium greater than five milliequivalents per liter), may be caused by increased potassium intake, decreased potassium excretion, or redistribution of potassium caused by medications or supplements. Signs and symptoms of hyperkalemia include cardiac (heart) and neuromuscular effects, although patients may not show symptoms. Hyperkalemia may cause skin numbness, generalized weakness, paralysis, listlessness, dizziness, confusion, low blood pressure, blood in the stool, abnormal heart rhythms, and death.

Potassium may cause low blood pressure. Caution is advised in patients with low blood pressure or heart conditions, and in those taking drugs that lower blood pressure.

Avoid solid dosage forms of potassium supplements in patients at risk for arrest or delay in tablet passage throughout the gastrointestinal (GI) tract. Avoid lying down after administration, to prevent delayed passage through the GI tract.

Avoid wax matrix potassium chloride preparations in heart patients with esophageal compression due to an enlarged left atrium.

Oral potassium chloride should be taken with food and/or a full glass of water to prevent gastrointestinal irritation.

Fluid balance, electrolyte concentrations, and acid-base balance should be monitored regularly in patients on potassium therapy to prevent abnormally high or low levels of potassium and other electrolytes. Hyperkalemia has occurred in human trials utilizing potassium supplementation. Hypoglycemia has occurred in human trials utilizing glucose-insulin-potassium (GIK). Postoperative potassium estimations should be calculated frequently during postoperative potassium supplementation to prevent life-threatening complications due to potassium imbalances.

Pseudohyperkalemia is a rise in the amount of potassium that occurs due to excessive leakage of potassium from cells, during or after blood is drawn, that is caused by hemolysis during venipuncture. It has been found to be a laboratory artifact that is not uncommon in patients with cancer or increased white cell counts.

Pregnancy and Breastfeeding

Potassium supplementation at higher than normal dietary levels in pregnant and lactating women is not recommended, due to a lack of sufficient data. Infant formulas contain potassium.

McCarty MF. Scavenging of peroxynitrite-derived radicals by flavonoids may support endothelial NO synthase activity, contributing to the vascular protection associated with high fruit and vegetable intakes. Med Hypotheses. 2008;70(1):170-81.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.